Mind-Body Councelling Services - Carole Fawcett - helping you find the answers - www.amindfulconnection.com
Counselling Services

Telephone Counselling Information Form
Carole Fawcett Counselling & Hypnotherapy Services
www.amindfulconnection.com Ph/text 250-550-0316

** Please note that you have to be 19 years old
to access telephone counselling.

Please indicate you have read and understand this
by answering the following questions

* Name: 
* Email: 
* Age
* Address
* Phone (Cell):
   Phone (Land):
* Length of Telephone Counselling Session Requested: 1/2 Hour 1 Hour
* Reason for requesting counselling:
* Have you had counselling in the past?
* Have you been diagnosed with any mental health issues?

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